In Illinois, Medicare Part D provides prescription drug coverage for Medicare beneficiaries. Original Medicare (Parts A and B) only covers prescription medications in extremely limited circumstances, such as drugs that are administered by a medical provider in a hospital setting. Self-administered medications that you would fill in a pharmacy are not covered by Original Medicare. For comprehensive prescription drug coverage, you’ll need to join a Part D prescription drug plan.
Medicare Advantage prescription drug plans in Illinois
If you have a Medicare Advantage (MA) plan, it may include prescription drug coverage. Known as a Medicare Advantage Prescription Drug (MA-PD) plan, these "all-in-one" plans provide the same coverage you'd get by pairing Original Medicare with a Part D plan. In addition, many MA plans offer extra benefits, like routine vision and dental care, hearing aids, and fitness programs.
Not every Medicare Advantage plan includes a prescription drug plan, however. You need to check the individual plans that are available in your part of Illinois to see what they cover before you commit and enroll.
If you choose to sign up for a Medicare Advantage Prescription Drug plan, you will not be able to purchase a standalone Part D Prescription Drug plan. Signing up for a standalone Part D plan when you already have an MA-PD plan means you will be automatically disenrolled from your MA plan. You will then be placed back into Original Medicare.
Medicare Part D plans in Illinois are offered by private insurance companies that are contracted with Medicare. Availability and costs vary according to the plan and provider you choose.
Eligibility for Medicare Part D coverage in Illinois
You first become eligible for Medicare Part D when you have Medicare Part A and/or Medicare Part B and live in the Part D plan's service area.
As with the Medicare program as a whole, you can only enroll in a Part D plan during specific times. There are several enrollment periods during which you can register for Medicare Part D in Illinois, including:
- Your Initial Enrollment Period (IEP)
- Annual Enrollment Period (AEP)
- Medicare Advantage Open Enrollment Period (OEP)
- Special Enrollment Period (SEP)
When is the Medicare Initial Enrollment Period?
Your Initial Enrollment Period occurs when you first qualify for Medicare. It lasts for a full 7 months, beginning 3 months before your 65th birthday and extending through your birth month and the 3 months after you turn 65.
If you qualify for Medicare due to a disability, you're automatically enrolled during your 25th month of collecting Social Security disability benefits. However, you also get an Initial Enrollment Period that begins 3 months before your 25th month and ends 3 months after it, for a full 7 months. You can use your IEP to sign up for a Part D or Medicare Advantage (MA) plan.
Those who qualify for Medicare due to a diagnosis of amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) are automatically enrolled in Medicare Parts A and B the first month they receive disability benefits. If you have end-stage renal disease (ESRD), you qualify for both Parts A and B but must choose to enroll.
To qualify for Medicare at any age, you must be a U.S. citizen or permanent resident for 5 years or more.
It’s important to note that if you don’t enroll in Medicare Part D when you first qualify, you won’t have prescription drug coverage and you’ll have to pay for your medications out-of-pocket. If you decide to enroll later, then you may have to pay a late fee on top of your monthly premium for the entire time you have Medicare Part D.
Additional Part D enrollment periods
If you didn't register when you first qualified, you can sign up for a Part D plan during the Annual Enrollment Period . Annual Enrollment runs from October 15 through December 7. During this time, you can enroll in a Part D plan, change Part D prescription plans, decide to enroll in Medicare Advantage, or switch from Medicare Advantage back to Original Medicare with a standalone Part D plan.
Medicare beneficiaries who are currently enrolled in an Advantage plan can take advantage of the Medicare Advantage Open Enrollment Period. The only changes you can make during this time are switching to a different MA plan or returning to Original Medicare. However, if any changes you make during OEP result in you losing prescription drug coverage, you may sign up for a new Part D plan.
The Open Enrollment Period starts on January 1 and lasts through March 31 each year.
There are a few other limited circumstances during which you may be eligible to make changes to your Medicare prescription drug coverage. This is called a Special Enrollment Period, and there are numerous ways to qualify. Find the full list here.
How to choose Medicare Part D coverage in Illinois
Medicare Part D coverage in Illinois varies according to the plan you choose. Compare your Part D plan options carefully to ensure you get the best plan for your unique needs.
- Costs: Look beyond the monthly premium to understand the full cost of the plan. This includes the yearly deductible and copayments.
- Drug formulary: Even the best plan isn't the right one for you if it doesn't cover your prescriptions, so make sure you check the drug formulary. You may also want to look at the tier your prescriptions are on. All Part D plans use tiered pricing. Drugs on the lower tiers are less expensive than medications on the higher tiers.
- Pharmacy network: Most Part D plans use a pharmacy network, with beneficiaries enjoying lower out-of-pocket costs when they use a preferred pharmacy.
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